There are lots of causes of a stuffy nose, from colds and infections, hay fever and dust allergies to chronic nasal inflammation and non-allergic rhinitis. One type of nasal spray won’t cure all types of nasal blockage, so it’s important to know which one is which …

Different types of nasal spray

Side note: what does “topical” mean?

You will often see nasal sprays referred to as “topical”. This refers to the route of administration. Topical simply means that the drug is applied directly to the site it aims to treat, in this instance, the nose. This is the opposite to systemic administration, where the drug is usually swallowed or injected.

1. Antihistamine nasal sprays

In short, these are ideal for treating nasal blockage that arises due to allergy.

An allergy is when your body elicits an immune response – an infection-fighting tactic – to something non-infectious.

Histamine is a chemical inside the body that is released in high quantities in this immune response. Histamine and other chemicals rush to the site where allergens are detected (usually the nose and throat as this is the primary point of entry if breathing them in) and then bind to specific receptors to cause inflammation.

Antihistamines help to relieve your stuffy nose by reducing this inflammation via stopping histamine binding to other cells.

Summary: good for allergy sufferers, treats inflammation and runny nose, use when symptoms worsen.

Examples: azelastine, olopatadine

2. Steroid nasal sprays

Like antihistamines, these work by reducing inflammation. They can be suitable for treating allergies and non-allergic rhinitis or nasal polyps. Steroid nasal sprays are commonly prescribed to treat problematic snoring but can also be bought over-the-counter.

Side note – what is rhinitis?

Rhinitis simply means swelling in the nose. It is not a disease, but a term used to describe nasal symptoms including swelling, difficulty breathing and excess mucus. There are two categories of rhinitis:

Allergic rhinitis. This is an umbrella term for conditions like hay fever or nasal swelling experienced in response to other allergens.

The steroids in these nasal sprays are not to be confused with anabolic steroids used to build body mass. Nasal spray steroids are copies of naturally occurring hormones produced by glands above the kidneys.

Steroid nasal sprays reduce inflammation via several different mechanisms [2]. This includes stopping the function of a key enzyme which helps produce inflammatory chemicals in the body [3].

If prescribed steroid nasal sprays, remember that they are unlikely to provide instant relief and usually work after a few initial uses. If your nasal problems are chronic, you should use the spray regularly even if your symptoms improve.

Steroid nasal sprays don’t tend to produce any serious side effects and can be used by most people.

Summary: good general nasal spray for a variety of conditions, especially for people with chronic nasal inflammation, can be used long-term

Examples: mometasone, fluticasone, beclometasone

3. Anticholinergic nasal sprays

This type of nasal spray is best to treat a runny nose. They reduce the amount of mucus that your nose produces and are suitable for a variety of causes of nasal blockage from allergic to non-allergic.

Unlike antihistamines and steroid spray, anticholinergic sprays will not relieve the inflammation and congestion. The side effect profile is typically mild.

Anticholinergic sprays work by blocking receptors which ordinarily lead to activation of nasal mucus glands and hence mucus production [4].

Summary: good for snorers with a runny nose

Example: ipratropium bromide

4. Decongestant nasal sprays

Congestion in the nose is caused by dilation (expansion) of blood vessels, reducing the space for air to flow freely. Decongestant nasal sprays work by constricting these blood vessels to widen your nasal passages.

Decongestants can be very effective in relieving a blocked nose in the short term, and most can be bought over-the-counter. However they are not suitable for everybody. Children, pregnant or breastfeeding women and people with high blood pressure shouldn’t use decongestant nasal sprays (this is because constricting blood vessels further increases blood pressure).

Decongestants are suitable for short-term use: a few times a day for no longer than a week. This is because overuse of decongestants can cause rebound congestion where the spray starts to have the opposite effect and cause nasal stuffiness.

Summary: good for nasal blockage caused by short-lived problems like a cold, should only be used short-term to avoid rebound congestion

Example: pseudoephedrine

5. Mast cell inhibitors

This type of nasal spray is suitable for those who suffer from seasonal allergies and can predict when their symptoms will arise. Because mast cell inhibitors are preventative, they need to be used a couple of weeks before the onset of symptoms.

These sprays work in a similar fashion to antihistamines in that they stop mast cells (a type of immune cell) from breaking down and releasing inflammation-causing histamine.

Summary: suitable to long-term sufferers of hay fever who can time the onset of their symptoms

Example: cromolyn

6. Saline nasal sprays

Saline nasal sprays are non-medicated. Instead, they are a mixture of water and salt (sodium chloride) which moisturize your nasal passages to soothe inflammation and can also break down excess mucus.

This type of spray works in a very similar way to using a neti-pot, the only difference is the mode of delivery. Because saline nasal sprays are non-medicated (though do read the label, some are “combination” sprays containing some medication), they can be used by nearly everyone, including children.

Saline nasal sprays can also be used to make other snoring remedies work better. Steroid sprays don’t work well if there is a lot of mucus present. Using a saline spray first can help break up excess mucus, allowing medicated sprays to work more effectively. Saline sprays can also help to moisten your airways before using CPAP.

Summary: suitable for all and useful for soothing chronic nasal inflammation and clearing excess mucus, can be used as an adjunct to other remedies